Do You Have a Healthcare Fraud Case Under the False Claims Act?

What is healthcare fraud?

Healthcare fraud under the False Claims Act encompasses schemes to improperly obtain payment from Medicare, Medicaid and other federal and state health insurance programs.

The qui tam provisions of the False Claims Act have been used by whistleblowers to recover billions of dollars of Government funds taken through all sorts of healthcare fraud schemes against the Medicare, Medicaid, and TRICARE programs. For over 20 years, VSG qui tam attorneys have been successfully representing whistleblowers in healthcare fraud cases.

There are many different kinds of healthcare fraud schemes. For example, a provider might be “upcoding” services, i.e., billing for medical services that should have been billed at a lower reimbursement level than what was actually billed. Or, a provider, such as a hospital or physician, might be rendering healthcare services that were not medically necessary or appropriate.

Conversely, in long term care settings in which providers are paid a daily rate to deliver all care necessary to treat their patients, a provider may systematically fail to deliver medically necessary care to its patients.

Another type of health care fraud is when a provider bills a Government program for health care services which were provided to beneficiaries, but which should not have been paid for by Medicare or Medicaid because the provider was violating an important rule, such as the Anti-Kickback Statute, or the “Stark” law against self-referrals.

VSG Sample Healthcare Fraud Settlements

Stark Violations - Hospital Kickbacks Qui Tam Case

Hospital Kickbacks for Patient Referrals

HCA, Inc., the nation’s largest hospital chain at the time, paid $225.5 million to resolve claims by multiple qui tam whistleblowers that HCA unlawfully paid kickbacks to physicians, and violated the federal “Stark” law, to induce physicians to refer patients whose care would be billed to federal health programs.

Medical Device Fraud Lawsuit - Healthcare Whistleblower Cases

Defective Medical Devices

LifeScan, Inc., a medical device manufacturer, paid $30.6 million to settle allegations in a qui tam lawsuit that it sold defective blood glucose monitors to Medicare patients and failed to report adverse events to the FDA.

Medicare Whistleblower Lawsuit - Nursing Home Medically Unnecessary Services

Medically Unnecessary Services (Nursing Home)

Extendicare Health Services, Inc., a nationwide nursing home chain, paid $10 million to settle qui tam whistleblower claims that the company’s skilled nursing facilities were providing patients with unnecessary rehabilitation therapy services for the sole purpose of obtaining higher reimbursements from Medicare. Extendicare paid VSG client Tracy Lovvorn an additional $990,000 in settlement of her claims for unlawful retaliation and attorney’s fees.

See All General Healthcare Fraud Settlements

Hear From Our Clients

NOVARTIS PAYS $390 MILLION IN WHISTLEBLOWER CASE

"People who were suffering deserved better medical advice; someone had to stand up for them," said David Kester.

SEE MORE TESTIMONIALS